To evaluate factors affecting the diagnostic yield of flexible fiberoptic bronchoscopy
in evaluating solitary pulmonary nodules (SPNs).
Retrospective analysis of bronchoscopies performed over a 4-year period.
A tertiary teaching hospital.
One hundred seventy-seven patients with pulmonary nodules without endobronchial lesions
who underwent bronchoscopy with brushing, washing, and transbronchial biopsy.
There were 151 malignant and 26 benign lesions. The diagnostic accuracy of bronchoscopy
in malignant and benign lesions were 64% (97 of 151) and 35% (9 of 26), respectively.
The yield of bronchoscopy was directly related to lesion size (p < 0.001, chi(2)).
When lesions were grouped according to distance from the hilum, yields of bronchoscopy
in central, intermediate, and peripherally located lesions were 82, 61, and 53%, respectively
(p = 0.05, chi(2)). When we stratified distance from the hilum by lesion size, the
difference in yield was not significant. However, lesions </= 2 cm had a diagnostic
yield of 14% (2 of 14) when located in the peripheral third vs 31% (5 of 16) when
located in the inner two thirds of the lung. There was a trend toward higher combined
diagnostic yield in right middle and lingular lobes when compared to all other segments
(p = 0.09, chi(2)). Transbronchial biopsy, washing, and brushing were complementary
in improving the yield of bronchoscopy.
Size is the strongest determinant of diagnostic yield in bronchoscopy when evaluating
SPNs. The yield of bronchoscopy is particularly low in lesions </= 2 cm that are located
in the outer third of the lung. Thus, alternative diagnostic approaches may be preferable
in this situation.